These particular causal factors vary from patient to patient. Some women experience attacks more frequently around the time of their menstrual periods.

Migraine sufferers should avoid factors such as alcohol, lack of sleep and foods that are known to cause attacks.

What are the typical features of migraine?

People often use the word 'migraine' to refer to headaches of many different types. So-called 'classical' migraine attacks have several features:

headaches that occur in bouts of between roughly 4 to 72 hours

the headaches usually affect one side of the head at a time, although both sides may be affected in separate attacks

the headaches are usually throbbing and worsened by normal physical activity

nausea and/or vomiting

preceding symptoms, called 'aura', that most often are visual, such as zigzag lines or flashing lights across or at the edges of the fields of vision

other symptoms can include sensitivity to light and sound, or non-visual aura such as a sensation of tingling in the body.

Only about 15 per cent of people experience visual aura before an attack. 'Common migraine' refers to the majority who have all the other symptoms but no aura.

Rarely some people with migraine experience transient loss of power of a limb with severe attacks, or temporary difficulty with speech.

In addition to an interview, the doctor should also perform a physical examination. If there is any doubt about the diagnosis, the doctor will refer the patient to an expert on diseases of the brain (neurologist).

Diagnosing migraine

The first-ever attack of migraine can look like many other conditions, including meningitis or even a stroke – so great care can be needed in making the initial diagnosis.

Once several attacks have occurred, however, the pattern becomes recognisable as migraine type headaches do not persist longer than 72 hours – headaches that last for longer without stopping are not migraines.

Depending on the circumstances, it may be necessary for the person to see a specialist (neurologist) to have investigations such as a brain scan.

Other tests, such as those for 'allergies' or which seek to identify triggers for the migraine, are of little help. Blood tests are normal in migraine.

How is a migraine treated?

The first line of treatment is always to try and identify trigger factors, which means keeping a careful record of events, mainly of foods that have preceded an attack.

Particular foods are identified as migraine triggers in about 20 per cent of sufferers. The large female preponderance within migraine sufferers points to the importance of hormonal factors, such as the menstrual cycle, which are not modifiable.

Many women also find that the oral contraceptive pill worsens attacks, and if so it should be stopped. (Women who get migraines with aura, severe migraines regularly lasting over 72 hours despite treatment, or migraines that are treated with ergot medicines should not take the contraceptive pill.)

People suffering a migraine should try to rest in a dark, quiet room.

Treatment of migraine is most effective if given at the start of an attack.

Treatments for sufferers aged under 18 may differ from older patients, so it's important to discuss this with the pharmacist before buying any over the counter remedies.

Simple painkillers, such as paracetamol (eg Panadol), aspirin (eg Aspro clear) or NSAIDs, such as ibuprofen (eg Nurofen), can be effective at relieving migraine and are usually the first treatment tried.

They are preferably taken in soluble or liquid form because these are absorbed by the body faster.

If nausea or vomiting are a problem, suppositories may be preferable. Alternatively, an antisickness medicine can be taken with the painkiller. Migraleve contains co-codamol (paracetamol and codeine) in combination with the antisickness medicine buclizine.

Alternatively, your doctor may prescribe the anti-sickness medicines domperidone (eg Motilium) or metoclopramide(eg Maxolon); these also speed up the absorption of painkillers. There are products available that combine these with a painkiller, eg Paramax or Migramax.

If simple painkillers and anti-sickness medicines consistently fail to relieve migraine attacks, the most popular modern remedies are the 'triptan' group of drugs. These medicines include sumatriptan (Imigran), rizatriptan (Maxalt) and zolmitriptan (Zomig), among others.

They are all prescription medicines, with the exception of sumatriptan, which can now be bought from pharmacies as Imigran recovery. These drugs cause the blood vessels around the brain to contract, therefore counteracting the dilatation that seems to part of the initial migraine process.

They come in various forms, including nasal sprays, injections and tablets that dissolve on the tongue, which can be useful if nausea and vomiting are a problem during the migraine.

If attacks are sufficiently frequent or last a long time, preventive treatment or prophylactic treatment as doctors call it, may be recommended.

This usually involves taking daily medication, so may not be appropriate for people who suffer only occasional migraines.

It's worth noting that using any painkillers for headaches or migraines too often or for too long can actually make the headaches worse. If you find you're getting frequent migraines and are often taking painkillers, it's important to consult your doctor for advice.

Often several kinds of medication need to be tried and perhaps combined before the most effective treatment for each individual patient can be found.

Alternative therapies, such as homoeopathy and acupuncture, are popular even if the evidence supporting their effectiveness is poor or absent.

The herbal remedy Feverfew has shown some efficacy in preventing migraine and is available over-the-counter.

However, please speak to your doctor or pharmacist before taking if you are using any prescription or over-the-counter medication on a regular basis as some herbal remedies do not mix well with conventional treatments.

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